Regulatory Joe

Are you struggling to understand the many components of regulatory filing for health plans? Regulatory Joe demystifies these complexities with clarity and insight for everyone from seasoned managers to new professionals in the industry. Subscribe to stay up to date with the ever-evolving landscape of new guidelines for health plans.

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Episodes

Wednesday Mar 12, 2025

A major change is coming for health plan issuers—CMS is restructuring how Plan and Benefit Justification Forms are handled.
Starting in 2026, issuers will no longer upload Justification Forms alongside their Plan and Benefit Templates. Instead, CMS will generate them post-submission through the MPMS portal, limiting issuer control and introducing new timing challenges.
In this episode, we break down:
How the new MPMS Justification Form process works
What issuers need to do to prepare for compliance changes
Why early validation and version control will be critical moving forward
#CMSRegulations #HealthPlans #MPMS #PlanSubmission #HealthcareCompliance

Wednesday Feb 19, 2025

🚨 The 2026 Notice of Benefit and Payment Parameters (NBPP) is here! What does it mean for health plans?
In this episode of Regulatory Joe, we break down the latest ACA compliance updates for 2026, including key changes in AV calculations, special enrollment periods, state-based marketplace transitions, and income verification requirements. With CMS moving up the timeline for finalizing regulations, issuers have more time than ever to strategize—but also more details to analyze.
Key Topics Covered:✔️ The impact of the finalized 2026 NBPP on health plan filings✔️ CMS’s latest approach to AV calculator updates✔️ Special Enrollment Periods (SEPs) and subsidy expansion✔️ What new call center standards mean for issuers✔️ How state-based marketplaces (SBMs) are evolving
🔗 For more insights, visit: regulatoryjoe.co

Wednesday Jan 29, 2025

Join Joe Boyle, President of Regulatory Solutions at Penstock, as he breaks down CMS’s risk adjustment and user fee updates for benefit year 2025. This episode is your go-to guide for navigating the evolving regulatory landscape.
Here’s What You’ll Learn:
How CMS’s use of 2019–2021 data impacts 2025 submissions
The role of the American Rescue Plan in shaping membership trends and user fees
Key strategies for issuers entering new markets
Tips for compliance when serving AI/AN populations
Why predictive modeling is the future of risk adjustment
Whether you’re an established issuer or entering a new market, this episode is packed with actionable insights and practical recommendations to help you stay compliant, optimize processes, and prepare for the future of risk adjustment.
🎧 Listen now and make sure your team is ready for the 2025 submission season. Subscribe to Regulatory Joe for updates on regulatory filing for health plans, compliance tips, and more.

Wednesday Jan 08, 2025

SBM-FPs Explained: What Health Plans Need to Know
What are state-based marketplaces operating on the federal platform (SBM-FPs), and why are they becoming a popular choice for states? In this episode, Joe Boyle breaks it all down.
Learn the fundamentals of SBM-FPs, including how they operate, why states choose them, and the financial and operational implications for health plans. Joe also explains the transition process to standalone state-based marketplaces, the role of enhanced direct enrollment in maintaining a seamless member experience, and how carriers can align strategies to navigate these changes.
Whether you're preparing for an SBM transition or want to better understand these hybrid models, this episode provides valuable insights for health plan professionals.
Listen now to stay informed, and don’t forget to like, share, and subscribe!

Wednesday Dec 04, 2024

In today’s episode of Regulatory Joe, we’re diving into the 2025 Rates and Benefits Information System (RBIS) updates, highlighting what health plans need to know to ensure accurate and compliant submissions.
📌 Key Takeaways:
The new four-window CMS schedule and how to stay ahead of critical deadlines
Updated URL submission criteria and best practices for mapping and validation
Tips for ensuring data accuracy and avoiding common RBIS submission errors
And more!
🔔 Subscribe for more regulatory insights and health plan updates!

Wednesday Nov 13, 2024

In today’s episode of Regulatory Joe, we’re taking listeners through the 2025 Actuarial Value (AV) calculator, a tool that ensures plans meet standards for each metallic tier.
📌 Key Takeaways:
Consistent AV ranges for 2025 across all metallic tiers, with no major changes
Early testing with the draft AV calculator to stay on track with compliance
Best practices for version control and documentation when running the AV calculator
And more!
🔔 Subscribe for more regulatory insights and health plan updates!

Tuesday Oct 29, 2024

In this episode of Regulatory Joe, we break down the critical changes to Healthcare.gov that will reshape health plans in 2025. From streamlined enrollment to simplified plan selection, we dive into how these updates will impact issuers and plan operations in both federally facilitated and state-based marketplaces.
📌 Key Takeaways:
How the election results could reshape federal and state control over ACA marketplaces
The future of American Rescue Plan (ARP) insurance subsidies
What will happen with the newly released draft of the 2026 NBPP
And more!
🔔 Subscribe for more regulatory insights and health plan updates!

Wednesday Oct 09, 2024

In this episode of Regulatory Joe, we break down the critical changes to Healthcare.gov that will reshape health plans in 2025. From streamlined enrollment to simplified plan selection, we dive into how these updates will impact issuers and plan operations in both federally facilitated and state-based marketplaces.
📌 Key Takeaways:
Consistent user experience across Healthcare.gov and state exchanges
Simplified plan selection to reduce confusion for enrollees
Best practices for testing and syncing plan data
And more!
🔔 Subscribe for more regulatory insights and health plan updates!

Wednesday Sep 18, 2024


In this episode of Regulatory Joe, we cover the critical changes coming in 2025 for the Notice of Benefit and Payment Parameters (NBPP).
Learn how telehealth, prescription drug access, re-enrollment rules, and network adequacy standards will shape health plans next year.
📌 Key Takeaways: Expanded telehealth documentation requirementsPrescription drug coverage updatesNew re-enrollment hierarchy rulesStricter network adequacy standards
🎧 Listen to the podcast version on Spotify, Apple Podcasts, or wherever you get your podcasts!
🔔 Subscribe for more health plan regulatory updates! #2025NBPP #HealthPlans #RegulatoryJoe

Wednesday Aug 07, 2024

In today’s episode of Regulatory Joe, we’re diving into an important topic that is shaping the future of health plan offerings: Essential Health Benefit (EHB) benchmark updates.
Don't miss an episode! Hit subscribe or get email notifications by signing up at regulatoryjoe.co today.

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Penstock Group

Penstock is a service partner and SaaS builder for forward-thinking health plans and providers, empowering recovery, audit and regulatory teams to get accuracy right from the start—when it matters most. Learn more here.
 

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